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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PROJECT ADDRESS 4GC13 <br />Mnei Mail Address City StateOp Phone <br />Tenant Mail Address City Stato/Zip Phone <br />i <br />Electrical Ccnlractor Mail Address City �SState/Zip Phone <br />Zr/G <br />State License Number Contract P ice of Work <br />Proposed Use of Building / Contact Person lPlan Review) <br />Description of Work to Be Done: Iw) /�h jV 11R o 7L/ I'L l-.( -f <br />NOTE: WIRING IN NON -DWELLINGS IS REQUIRED TO FEE <br />BE IN RACEWAYS, MC OR AC CABLE. 5003 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 here6 <br />by certifv that 1 have read and examined this application and know the same to be true end I�O I _ A <br />correct. All provisions of laws and ordinances governing this type of work will be completed D� <br />whether specified herein or not. The granting of a permit does not resume to give authority to <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performance of construction. That I am authorized by the owner of this property to perform the <br />work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />7 <br />� Signature Date <br />